Background

The video laryngoscope (VL) Aand (DL) was introduced to aid visualization of the glottis during intubation in critically ill children.

Objectives

Be able to differentiate using direct laryngoscope and videolarynsgocope in children.

Methods

All intubations occurring in pediatric intensive care unit were collected on a prospective database. VL was introduced in our unit September 2016. We studied data 1 year prior to and 1 year after introduction of VL. Categorical and continuous data were presented as counts (percentages) and median (interquartile range). Comparison between the VL and DL group were made using the Chi-square test and Mann-Whitney U test as appropriate

Results

A total of 182 intubations performed in our PICU over 2-year study period. Median age of patients requiring intubation was 0.5 (0.0, 4.3) years. Majority of intubations were emergent 141/182 (77.5%) the main indication was ventilation failure [45/182 (24.7%)]. No difference in the proportion of out-of-hours intubation [35 (35.0) vs 32 (39.0); p=0.644] and oral route of intubation [90 (90.0) vs. 72 (87.8); p=0.643] between the two groups. The number of intubation attempts were similar in the VL and DL groups [1 attempt in 50 (61.0) vs. 65 (65.0), 2 attempts in 17 (20.7) vs. 19 (19.0) and >/= 3 attempts in 15 (18.3) vs. 16 (16.0) respectively; p=0.851]. The oxygen saturation during intubations were similar in the VL and DL groups [pulse oximetry 95 (70, 100) % vs. 97 (73, 100) %; p=0.178].

Conclusion

There was no difference in the number of intubation use of VL as compared to DL.

Background

Acute myocarditis is a rare condition in pediatrics, but potentially lethal, that can culminate in cardiac disfunction and, rarely, intracardiac thrombus.

Objectives

Not Applicable

Methods

Not Applicable

Results

We report the case of a 16-year-old teenage male, previously healthy, that was transfered to the Pediatric Intensive Care Unit due to suspicion of acute myocarditis with multiorgan disfunction. Echocardiogram at admission revealed moderate to severe left ventricular (LV) disfunction (ejection fraction of 30-35%) and two hyperechoic masses in the LV suggestive of thrombus, given which he initiated non-fractionated heparin. The cardiac magnetic resonance at day 4 was compatible with acute myocarditis with moderate to severe ventricular disfunction and biventricular thrombus. Of the infectious investigation, the only relevant finding was a positive fecal culture for Campylobacter jejuni; remaining microbiological, immunological, and prothrombotic studies were negative. Despite the treatmentwith ceftriaxone, azithromycin and IV immunoglobulin, there was an increase of the thrombus, with decline of cardiac function and peripheric arterial embolization, which led to surgical thrombectomy on day 13. He was maintained on extracorporeal membrane oxygenation until day 28, when he was subjected to orthotopic cardiac transplant with no complications. Evolution was favorable, with progressive improvement of cardiac function and no recurrence of thrombus.

Conclusion

We present a case of acute myocarditis complicated with intracardiac thrombus and systemic embolization. The approach to these cases should be multifactorial and multidisciplinary and the decision of surgical treatment is difficult. Despite severe cardiac dysfunction and intraoperative risk of embolization, the surgery was successful and should be considered in the absence of improvement with medical treatment.

Background

We reported here a rare case of acquired lung hernia in a 3 months Down syndrom infant after a surgical Left thoracotomy at 1 month age.

Objectives

Description of rare surgical complication

Methods

Surprisingly, this hernia will be symptomatic only after second surgery (Atrio-ventricular communication) with chest X-Ray large intercostal hernia and 2x2cm hernia visible to the naked eye. Hernia was uncovered probably second to mechanic positive ventilation, pulmonary hyperpressure caused by laryngo-tracheomalacy with cough. Finally patients was discharged at home without needed any intervention on hernia and was not symptomatic at this time.

Results

Hernias are rare (less than 300 cases before 1996). 65% are inter costal. 60 to 82% are acquired : post traumatic (rib fracture have to be particularly watched), post surgery (more often after mini invasive surgery because of less meticulous chest closure) or chest tube. In children they are often congenital and don’t required any treatment. Sometimes additional cofounding factor could be incriminated : tissue weakness, denutrition, Recklinghausen, obesity, infection or tumor). Hernia can be symptomatic just after trigger factor or several years after. Chest X-ray is usefull but CTscan is gold standard exam to evaluate defect size and pulmonary parenchyma status. Valsava Manoeuver could have help to reveal it too.

Concerning surgical prevention : using of small trocars and close carefully chest wall, avoid infections.

Conclusion

Even if most of time they are asymptomatic, it should be evocated in chest pains after trauma or thoracic surgery.